Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2014
Comparative StudyEarly Goal-Directed Therapy in Pediatric Septic Shock: Comparison of Outcomes "With" and "Without" Intermittent Superior Venacaval Oxygen Saturation Monitoring: A Prospective Cohort Study.
To evaluate the effect of intermittent central venous oxygen saturation monitoring (ScvO(2)) on critical outcomes in children with septic shock, as continuous monitoring may not be feasible in most resource-restricted settings. ⋯ Early goal-directed therapy using intermittent ScvO(2) monitoring seemed to reduce the mortality rates and improved organ dysfunction in children with septic shock as compared with those without such monitoring.
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Pediatr Crit Care Me · May 2014
Observational StudyThe Lack of Specificity of Tracheal Aspirates in the Diagnosis of Pulmonary Infection in Intubated Children.
Ventilator-associated pneumonia is the first or second most commonly diagnosed nosocomial infection in the PICU. Centers for Disease Control diagnostic criteria include clinical signs or symptoms in conjunction with a "positive" tracheal aspirate, defined as more than 10 colony-forming units/mL of bacteria on quantitative culture and/or more than 25 polymorphonuclear neutrophils per low-power field on Gram stain. We hypothesized that tracheal aspirate cultures and Gram stains would not correlate with clinical signs and symptoms and would therefore not distinguish between colonization and infection. ⋯ Positive bacterial cultures of tracheal aspirates increase rapidly after intubation and usually include bacteria considered to be pathogens. Tracheal aspirate cultures and Gram stains do not appear to distinguish between infection and colonization. Antibiotic regimens that include cefepime decrease the frequency of positive cultures, but the significance of this is unclear.
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Pediatr Crit Care Me · May 2014
The Association of Carotid Artery Cannulation and Neurologic Injury in Pediatric Patients Supported With Venoarterial Extracorporeal Membrane Oxygenation.
To describe the prevalence of neurologic injury in a recent cohort of patients 18 years old or younger cannulated for venoarterial extracorporeal membrane oxygenation. To evaluate the association of carotid artery cannulation with neurologic injury when compared with other cannulation sites. To determine if age impacts the association of carotid artery cannulation with neurologic injury. ⋯ Carotid artery cannulation for venoarterial extracorporeal membrane oxygenation in patients 18 years old or younger is associated with statistically significant increased odds of neurologic injury. These increased odds are present across all age groups.